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Jason Luty refers to the 'dark side' of psychiatry. He cites the Nazi holocaust as being assisted with cruel zeal by psychiatrists. I believe that he makes some extrapolations into the present from this gruesome past, and psychiatrists are advised to be less authoritarian. For example, there is personality disorder as a potentially
vague diagnosis that allows psychiatrists to lock up too many vulnerable people.

Jason Luty refers to the 'dark side' of psychiatry. He cites the Nazi holocaust as being assisted with cruel zeal by psychiatrists. I believe that he makes some extrapolations into the present from this gruesome past, and psychiatrists are advised to be less authoritarian. For example, there is personality disorder as a potentially
vague diagnosis that allows psychiatrists to lock up too many vulnerable people.

Luty does not, however, mention community treatment orders (CTOs), yet these are a current example of the human rights of patients being compromised by
psychiatrists. A recent paper (1) by Tom Burns at Oxford found them to be ineffective, but psychiatrists seem enthusiastic about them.

Several correspondents in the Lancet and the Psychiatric Bulletin have attacked the Burns article on two fronts.

The first is lack of statistical power. Burns confirmed the null hypothesis - of no difference between intervention (CTO) and control (Mental
Health Act Section 17 leave) - with a relative risk of 1.0. The narrow confidence interval (CI 0.75-1.33) seems to imply sufficient power. Of course, one can increase sample size and power ad infinitum; however, the clinical
importance may be negligible.

The second front of criticism involves psychiatrists who cite individual cases where CTOs appear appropriate, viz. anecdotal guesswork. In the more
primitive days of psychiatry, papers in journals had no statistical analysis.
Instead, accumulated case studies were used to justify procedures such as lobotomy. Individual case studies are not as rigorous as randomized controlled studies such as that used by Burns.

CTOs actually put patients at risk. Clinicians mistakenly have faith in CTOs as 'miracle interventions', whereas CTOs in practice mean that severely ill patients are abandoned in the community. Some chronically unwell people with schizophrenia cannot cope without annual stays in hospital as respite. CTOs will never compensate for the catastrophic reduction in psychiatric beds due to
short-sighted cost cutting in the NHS.

Given its vicious history, any measure in psychiatry that reduces patients' rights should provoke suspicion.